Provider Demographics
NPI:1770094245
Name:BROWN, SHEREKA (BIBLICAL COUNSELOR)
Entity type:Individual
Prefix:MRS
First Name:SHEREKA
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:BIBLICAL COUNSELOR
Other - Prefix:MRS
Other - First Name:SHEREKA
Other - Middle Name:
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:219 LEONARD CT
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-1497
Mailing Address - Country:US
Mailing Address - Phone:678-357-4547
Mailing Address - Fax:
Practice Address - Street 1:219 LEONARD CT
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-1497
Practice Address - Country:US
Practice Address - Phone:678-357-4547
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-23
Last Update Date:2017-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA08222017-P9101YP2500X, 374K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374K00000XNursing Service Related ProvidersReligious Nonmedical PractitionerGroup - Single Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty